The stellate ganglion is an autonomic nervous ganglion, formed by the fusion of the inferior cervical sympathetic ganglion and the first thoracic sympathetic ganglion, which is present in about 80% ...of people. It is anterior to the neck of the first rib and contains neurons that supply sympathetic innervation to the head and neck. Injection of local anesthetics near the stellate ganglion (stellate ganglion block; SGB) has been used for multiple clinical indications including sympathetic-mediated pain and vascular insufficiency syndromes of the upper extremity. In addition, reports on SGB having significant impact on conditions linked to immune dysfunction have been published for a century, but the mechanisms of SGB action have been poorly understood.
SGB hinders the sympathetic innervation of the immune organs, thus modulating the immune system activity and leading to the alleviation of the disease.
All primary (thymus and bone marrow) and secondary immune organs (spleen, lymph nodes, mucosa-associated lymphoid tissue) receive a substantial sympathetic innervation, with norepinephrine (NE), as the main neurotransmitter. Complementarily, T and B lymphocytes express β2-adrenergic receptors, while innate immune cells express both α- and β-adrenergic receptors. The consequences of adrenergic receptor signaling can be summarized as immuno-modulatory. Activation of adrenergic receptors leads to decreased levels of pro-inflammatory cytokines (e.g. IL-1β, IL-6, TNF-α) and increased levels of anti-inflammatory cytokines, like IL-10 or TGF-β. Cellular changes include increase in the number of regulatory T cells and shift of the Th1/Th2 balance towards the Th2 response. Since the changes in immune response are global, the explanation has to include generalization of the SGB effect. A likely explanation includes centripetal neuronal pathways between the stellate ganglion and deep brain regions such as insula, amygdala, and hippocampus. Those, in turn, have reciprocal innervation with locus ceruleus, a brain-stem structure involved in the control of the autonomous nervous system.
Various pathologic conditions have been shown to be SGB responsive, where the symptoms have been reduced or eliminated. Many of those clinical improvements have been mirrored by measurable immunologic changes. A plausible explanation, consistent with the evidence available so far, is that SGB exerts its effects by regulating the immune system, through a central, reflex-like pathway. Our hypothesis provides a theoretical framework for understanding the effects of SGB and could, thus lead to wider usage of the technique in immune-linked disorders such as ulcerative colitis.
•Sulfate resistance of concretes made of RCA (5% Na2SO4 and 5% MgSO4 solutions).•RCA could be used for preparation of sulfate resistant concrete.•Concrete microstructure changes analized by SEM, ...BSE-EDS, XRD and FTIR analyses.
The paper deals with the results of sulfate resistance of eight concrete mixtures with coarse recycled concrete aggregate/natural aggregate, CEMI/CEMIII and two different water-to-cement ratios (w/c). These concretes were immersed in 5% Na2SO4 or 5% MgSO4 solutions for 90, 180 and 365days. The evaluation of sulfate resistance was done by determination of compressive strength and length change. Concrete specimens submerged in both solutions up to 365days, containing recycled concrete aggregate, CEM III and both w/c ratios, showed good resistance to sulfate attack. Characteristics related to microstructure (SEM, BSE-EDS, XRD and FTIR) were analysed on the concrete which was not sulfate resistant.
Implementing a circular approach through waste valorization in mortar production with environmentally efficient mix design is a viable pathway for relieving the ecological burden of greenhouse gas ...emissions, resource depletion and waste management. The main objective of this paper is to evaluate the feasibility of using fly ash (FA), corn cob ash (CCA), and ceramic waste powder (CWP) as supplementary cementitious materials (SCM) in cement–lime masonry mortars. As part of an extensive experimental study, twelve mortar mixtures were made: three reference and nine blended, with mixing ratios of 1:1:5, 1:0.7:4.2, and 1:1:4 ((cement + SCM)/lime/sand), by volume. The examined properties include workability, compressive and flexural strengths, dry bulk density, capillary water absorption, adhesive bond strength, and water vapor permeability. The compressive and flexural strengths of tested mortars were notably impaired, with reductions of up to 60%, while the capillary water absorption coefficient rose by 100% compared to the reference values. The adhesive bond strength of some blended mortars exceeded the strength of the reference mortars. Nevertheless, all blended mortars fulfilled the requirements for general-purpose mortars, while the majority met the criteria for structural masonry applications. In addition, a performance-based index and weighting triangle were used for the comparison and ranking of all analyzed mortar mixtures. The findings of this study may herald a novel use of FA, CCA, and CWP as more eco-friendly binding materials in contemporary construction leading to the reduction in the process’s carbon footprint, the improvement in cost efficiency, and the mitigation of the detrimental environmental impact of waste disposal.
To assess the attitudes of nursing students toward artificial intelligence.
Possible applications of artificial intelligence-powered systems in nursing cover all aspects of nursing care, from patient ...care to risk management. Although the final acceptance of artificial intelligence in practice will depend on positive 'nurses' attitudes toward artificial intelligence, those attitudes have gained little attention so far.
A cross-sectional multicenter study.
The study was performed at nursing schools of four Croatian universities, surveying a total of 336 first-year nursing students (response rate 69.7%) enrolled in 2021. A validated instrument, the General Attitudes towards Artificial Intelligence Scale, consisting of 20 Likert-type items, was chosen for the study. Where applicable, the items were contextualized for nursing. Four sub-scales were identified based on the outcomes of the factor analysis.
The average attitude score was (mean ± standard deviation) 64.5 ± 11.7, out of a maximum of 100, which was significantly higher than the neutral score of 60.0 (p < 0.001). The attitude towards AI did not differ across the universities and was not associated with students’ age. Male students scored slightly higher than their female colleagues. Scores on subscales “Benefits of artificial intelligence in nursing”, “Willingness to use artificial intelligence in nursing practice”, and “Dangers of artificial intelligence” were favorable of artificial intelligence-based solutions. However, scores on the subscale “Practical advantages of artificial intelligence” were somewhat unfavorable.
First-year nursing students had slightly positive attitudes towards artificial intelligence in nursing, which should make it easier for the new generations of nurses to embrace and implement artificial intelligence systems. Reservations about artificial intelligence in daily nursing practice indicate that nursing students might benefit from education focused specifically on applications of artificial intelligence in nursing.
To combat environmental challenges-such as the depletion of natural resources and a high carbon footprint-and contribute to the effort of achieving zero-waste technology and sustainable development, ...the use of agricultural and industrial wastes in the cement industry has created a research interest. This study explores the potential of two types of harvest residue ash (HRA) and three types of ceramic waste (CP) as supplementary cementitious materials (SCMs) through: (1) the characterization of raw materials and (2) examining the physical properties and mechanical performance of cement-based mortar samples prepared with 10%, 30% and 50%wt of the selected SCMs ground into powder form as cement replacement. Two main variables were the water-to-binder ratio (w/b) and the effect of different grinding procedures. Experimental results demonstrated that flexural and compressive strengths were not significantly impaired by SCM additions of up to 50%, but higher replacement levels led to an increased permeability and higher capillary water absorption due to the dilution effect. Also, a lower w/b was shown to effectively reduce the porosity of mortar and increase its mechanical properties, allowing for higher shares of SCMs to be utilized. This study verifies the technical feasibility of cob corn ash and ceramic powder application as SCMs in mortar formulations, further promoting the practice of incorporating industrial and agricultural by-products in greener cementitious composites.
The involvement of high mobility group box-1 (HMGB1) in various inflammatory and autoimmune diseases has been documented but clinical trials on the contribution of this pro-inflammatory alarmin in ...children with juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE) are basically absent. To address the presence of HMGB1 and a soluble receptor for advanced glycation end products (sRAGE) in different subtypes of JIA and additionally in children with SLE, we enrolled a consecutive sample of children harvested peripheral blood as well as synovial fluids (SF) at diagnosis and correlated it with ordinary acute-phase reactants and clinical markers.
Serum and synovial fluids levels of HMGB1 and sRAGE in total of 144 children (97 with JIA, 19 with SLE and 27 healthy controls) were determined by ELISA.
The children with JIA and those with SLE were characterised by significantly higher serum levels of HMGB1 and significantly lower sRAGE levels compared to the healthy controls. A positive correlation between serum HMGB1 and ESR, CRP, α2 globulin was found while serum sRAGE levels were inversely correlated with the same inflammatory markers in children with JIA. Additionally, high level of serum HMGB1 was related to hepatosplenomegaly or serositis in systemic onset JIA.
The inverse relationship of the HMGB1 and its soluble receptor RAGE in the blood and SF indicates that inflammation triggered by alarmins may play a role in pathogenesis of JIA as well as SLE. HMGB1 may serve as an inflammatory marker and a potential target of biological therapy in these patients. Further studies need to show whether the determination of HMGB1 levels in patients with JIA can be a useful guideline for detecting disease activity.
Glycosylation of immunoglobulin G (IgG) influences IgG effector function by modulating binding to Fc receptors. To identify genetic loci associated with IgG glycosylation, we quantitated N-linked IgG ...glycans using two approaches. After isolating IgG from human plasma, we performed 77 quantitative measurements of N-glycosylation using ultra-performance liquid chromatography (UPLC) in 2,247 individuals from four European discovery populations. In parallel, we measured IgG N-glycans using MALDI-TOF mass spectrometry (MS) in a replication cohort of 1,848 Europeans. Meta-analysis of genome-wide association study (GWAS) results identified 9 genome-wide significant loci (P<2.27 × 10(-9)) in the discovery analysis and two of the same loci (B4GALT1 and MGAT3) in the replication cohort. Four loci contained genes encoding glycosyltransferases (ST6GAL1, B4GALT1, FUT8, and MGAT3), while the remaining 5 contained genes that have not been previously implicated in protein glycosylation (IKZF1, IL6ST-ANKRD55, ABCF2-SMARCD3, SUV420H1, and SMARCB1-DERL3). However, most of them have been strongly associated with autoimmune and inflammatory conditions (e.g., systemic lupus erythematosus, rheumatoid arthritis, ulcerative colitis, Crohn's disease, diabetes type 1, multiple sclerosis, Graves' disease, celiac disease, nodular sclerosis) and/or haematological cancers (acute lymphoblastic leukaemia, Hodgkin lymphoma, and multiple myeloma). Follow-up functional experiments in haplodeficient Ikzf1 knock-out mice showed the same general pattern of changes in IgG glycosylation as identified in the meta-analysis. As IKZF1 was associated with multiple IgG N-glycan traits, we explored biomarker potential of affected N-glycans in 101 cases with SLE and 183 matched controls and demonstrated substantial discriminative power in a ROC-curve analysis (area under the curve = 0.842). Our study shows that it is possible to identify new loci that control glycosylation of a single plasma protein using GWAS. The results may also provide an explanation for the reported pleiotropy and antagonistic effects of loci involved in autoimmune diseases and haematological cancer.
Background and Purpose: Orthotomicus erosus, Mediterranean pine engraver, is widely distributed across the Mediterranean and southern Europe, Asia and North Africa. It is considered as secondary pest ...found on recently dead or felled trees, but can also attack weakened living trees. In high population levels this species can attack healthy trees and cause their dieback. Severe outbreaks occur after dry periods, or after fire in adjoining stands in warmer parts of the Mediterranean region, while this scenario has never happened in Croatia up to now. Bark beetles are important forest pests which have already been researched and discussed in relation to climate change, indicating that the predicted increase in temperature would lead to higher survival rates and faster development, thus directly influencing their population dynamics. Increase in temperature may stimulate changes in insects’ rate of development, voltinism, population density, size, genetic composition, extent of host plant exploitation, longitudinal and latitudinal distribution. Since climate conditions might have changed in the last few years as predicted in the Mediterranean region, the aim of our research is to document the first outbreak with high population levels of O. erosus in Croatia.
Materials and Methods: The extent of dieback was evaluated by counting trees with dieback symptoms on diagonal transects plotted through each of 33 forest management sections of Marjan Forest Park (Split). Trunk sections from several trees with early stage symptoms were collected for further laboratory analysis, which consisted of incubation phase and subsequent morphological identification. During regular yearly surveys in forests of Croatia, the pest was observed on several sites and damages were recorded for both years 2017 and 2018. The records were entered into a map using QGIS version 3.2.1-Bonn. Spatial data was downloaded from DIVA-GIS server. Monitoring efforts were initiated in affected areas where 13 flight barrier pheromone traps (Theyson®) equipped with pheromone lure Erosowit® (Witasek, Austria) were set-up in late March in state-owned and privately owned forests across Dalmatia. Catches in the traps were collected and O. erosus adults were counted on a weekly basis in order to identify the abundance of the pest in monitored sites, as well as to obtain the first information about population dynamics and to assess voltinism.
Results: On-site survey and the evaluation of dieback extent included sampling of 5% of all trees in Marjan Forest Park ,and the results showed that 23% of all trees in the forest park were affected by dieback symptoms. Visual examination of trunks, branches and bark showed symptoms of bark beetle infestation, while preliminary on-site examination of the observed adults pointed out to O. erosus. After two weeks in controlled conditions, bark beetle adults started to emerge from trunk sections which were placed in several mesh cages for incubation. Morphological identification by using stereomicroscope and the key for European bark beetles resulted in identification of O. erosus species. Over the course of the year 2017 one more site was reported to be infested with O. erosus, and eight additional sites were reported over the course of year 2018. In total, 446 ha were reported as infested, varying in intensity, in several different management units of state-owned and privately owned forests. The total number of trapped beetles in pheromone traps varied largely among sites. Our data indicate that several generations (at least 5 generations per year) were present in the year 2018.
Conclusions: Sudden surge in observed damages, as well as the number of beetles trapped during monitoring, in years 2017 and 2018 throughout Aleppo pine forests in Dalmatia are the first record of O. erosus outbreak in Croatia. O. erosus is native to Croatia and so far it has been considered only as a minor pest whose outbreaks have never been recorded. Drought intensity and frequency and aridification trends in the research area (Dalmatia, Croatia) cause cumulative stress to trees and have increased O. erosus occurrence. O. erosus is expected to exhibit increased voltinism, better overwintering performance and earlier spring flights. Our first results confirm this epidemic stage of O. erosus with high abundances in Dalmatia in 2018 and at least 5 generations per year, which alter the population level of this pest. Finally, with high dispersal abilities of O. erosus through active flight and easy transportation with infested material (logs and branches with bark), O. erosus has the potential to become an important forest pest in Croatia. Thus, extensive studies on its biology, ecology, natural enemies and interaction with ophiostomatoid fungal species are needed in order to predict further spread and suggest viable and effective management measures.
Due to greenhouse gas emissions, the production of cement clinker is considered unsustainable and many attempts are being made to replace cement with alternative materials sourced from agriculture, ...industry and other urban practices, such as construction and demolition works. The aim of this paper is to analyze the effects of cement substitution by locally available waste materials in Serbia, such as fly ash (FA), blast furnace granulated slag (BFGS) and wheat straw ash (WSA), up to the 50% replacement volume rate in cement–lime mortars. As the effective application of supplementary cementitious materials (SCMs) in cement-based materials requires a comprehensive insight into their properties, a characterization of materials involving all relevant physical, chemical and mechanical tests is conducted. Ten different mortar mixed with ingredients of a volume ratio 1:2:4 (cementitious powder/lime/sand) were designed and their consistency, bulk density, capillary water absorption, flexural strength, compressive strength and thermal analysis (TGA/DTA) results were examined to determine the influence of the abovementioned SCMs on mortar properties. Research findings highlight the possibility of replacing cement with slag (50%), fly ash (30%) or wheat straw ash (30%) while maintaining its performance and improving the economic and environmental impacts of masonry mortar production.
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